Provider Demographics
NPI:1710420625
Name:THAILONG TRAN DDS LLC
Entity Type:Organization
Organization Name:THAILONG TRAN DDS LLC
Other - Org Name:PARK CENTER FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:THAILONG
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-776-9686
Mailing Address - Street 1:14207 PARK CENTER DR
Mailing Address - Street 2:STE 105
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5248
Mailing Address - Country:US
Mailing Address - Phone:301-776-9686
Mailing Address - Fax:301-776-9680
Practice Address - Street 1:14207 PARK CENTER DR
Practice Address - Street 2:STE 105
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5248
Practice Address - Country:US
Practice Address - Phone:301-776-9686
Practice Address - Fax:301-776-9680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-25
Last Update Date:2016-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16183261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental